How to solve ‘The NHS Problem’ (2)

Wholesale engagement with charity sector

Last time, I discussed the need for the NHS to differentiate between ‘treatment’ and ‘care’. In the last week, three stories have emerged to support this view:

1. Families are being told they have seven days to find their relative a space in a care home – or risk being taken to court (Daily Mail)

Dr Paul Flynn, chairman of the British Medical Association’s consultant committee, said: ‘Pressure on NHS services is at a critical point and cracks are beginning to appear.’

2. Care for people with learning disabilities is ‘failing’, report says (BBC News)

Simon Stevens, NHS England Chief Executive, said: ‘radical changes are needed in NHS and social care.’

3. Private equity giant Terra Firma looking to break up Four Seasons Care Homes (City AM)

Terra Firma, a ‘private equity giant’, bought Four Seasons from Royal Bank of Scotland for £825million two years ago. Now: ‘The plan would see the company divided into three: an arm to deal with NHS patients; one to handle paying customers; and another to focus on brain injuries and mental health.’

I do not understand this. Why the distinction between ‘NHS patients’ and ‘paying customers’?

All in all, based this week’s news alone, I think we can say NHS care is a mess.

The NHS – ‘treatment’ and ‘care’

Society in the 21st Century has developed to the extent that ‘care’ is our fastest growing, and most expensive, social need.

As an issue, ‘care’ needs to be addressed far more radically and creatively than it is now.

Further, as discussed in my last post, the better the NHS is at ‘treatment’, the more ‘care’ it will create.

Is the role of the NHS to ‘care’ for all of us all of the time for all time?

Is this what it was set up to achieve?

There are people who think that, because it is called the National ‘Health’ Service, the NHS should focus on keeping people healthy – avoiding, rather than treating, illness. I have met people in the Department of Health who hold this view.

In one sense it makes sense. The healthier we are, the less likely we are to get sick.

But surely this misses the point? The NHS was not established to be some sort of national health club. The NHS is ‘doctors and nurses’ – not ‘fitness instructors’ and ‘nutritionists’.

In this interesting lecture, ‘The Origins of the NHS‘, by Professor Virginia Berridge, it is clear that the original aim of the NHS was pure and simple – ‘better access to hospital treatment’:

‘Then came the Labour victory of 1945 and the NHS Act of May 1946. Bevan espoused the nationalization of the hospitals (state ownership and control under appointed local bodies) rather than local authority control which had been Labour Party policy until then.’

This is what we want the NHS for:

– when we feel sick, to see a GP (quickly and efficiently)

– if we need to go to hospital, to go to hospital (quickly and efficiently)

– in emergency, to get to A&E (quickly and efficiently)

The job of the NHS is to make sick people better – to provide ‘treatment’ – not to be some sort of all-encompassing health care advisor and provider.

The National Care Service (NCS)

So, what to do with patients who have needed ‘treatment’, but now need ‘care’?

We spend £110billion a year on the NHS but, when it comes to ‘care’, as the Chief Executive of NHS England said: ‘radical change is needed.’

I am calling for the launch of a new ‘National Care Service (NCS)’ in Britain.

And a wholesale engagement with the ‘charity’ sector.

How come?

Engagement with charities

We Brits are a very charitable people.

Charity UK‘ is an extraordinary thing. We have 164,097 charities. Total funds raised is over £60billion a year – enough to fill the hole in the NHS budget for the next ten years.

Here is a list of our top 1,000 charities. They are an eclectic bunch. Amongst them are Macmillan Cancer Support, the Alzheimer’s Society, the Stroke Association and Age UK.

If you had any of these illnesses – following your treatment by the NHS – wouldn’t you rather be cared for by specialists in the field and alongside other patients with the same problems as you?

For all the major illnesses – cancer, dementia, diabetes etc – I would like to see specialist centres of excellence – and care homes if necessary – managed by charities on a national and local basis.

These would be independent of the NHS and, like the NHS, not-for-profit but, unlike the NHS, with the professionalism and expertise of any top commercial organisation.

Funding? Please do not be put off. I will discuss funding in my next two posts.

I have bold, new, creative, society-changing ideas to reveal.

Charity in the UK

According to the Charities Commission, our top 1.2% of charities are responsible for 69.4% of funds raised.

Amazingly, the bottom 75% of all UK charities raise only 3.4% of total funds. Or, to put it another way, the smallest 123,179 charities raise £2.172billion.

Whereas the top 1,990 charities had an annual income to Sept 2014 of £44.68billion, no less.

These larger charities are managed by highly qualified professionals who would do a far better and more efficient job in managing ‘care’ than the mess we have now.

They are highly qualified professionals managing not-for-profit organisations.

This is what we need.

Funding? Please do not be put off. I will discuss funding in my next two posts.

I have bold, new, creative, society-changing ideas to reveal.

Department of Charities and Care (DOCC)

I propose a radical new initiative which, in its boldness and ambition, may be as great as the foundation of the NHS itself.

I am calling for the launch of a new Government Ministry to be called Department of Charities and Care (DOCC).

The new ‘National Care Service’ (NCS) would report in to DOCC, just as the NHS reports in to the Department of Health (DOH).

If this creates ‘competition’ and ‘tension’ between the two NHS and NCS services and the two DOH and DOCC departments, then so much the better. They won’t like it, but the DOH and the NHS need to be challenged by better organised, professionally managed ‘competitors’. From competition, accountability and improved performance must ensue.

Funding? Please do not be put off yet. I will discuss funding in my next two posts.

I have bold, new, creative, society-changing ideas to reveal.



About Hugh Salmon

Business leader. Adman. Writer.
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